Provider Demographics
NPI:1689371213
Name:QUAILL, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:QUAILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:EMLENTON
Mailing Address - State:PA
Mailing Address - Zip Code:16373-9740
Mailing Address - Country:US
Mailing Address - Phone:724-996-2935
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0001
Practice Address - Country:US
Practice Address - Phone:814-877-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN672695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN672695OtherPA RN LICENSE